退变性腰椎侧凸脊柱-骨盆参数测量及临床意义

Measurement of spinopelvic parameter in patients with degenerative lumbar scoliosis and its clinical significance

目的测量退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者骨盆-脊柱参数并分析其临床意义。方法选取2006年3月—2014年3月在本院脊柱外科就诊的DLS且有完整影像学资料的患者30例(DLS组)及影像学资料完整的无DLS者30例(对照组),测量2组的骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacrum slope,SS)、腰椎前凸角(lumbar lordosis,LL)、胸椎后凸角(thoracic kyphosis,TK)、矢状位平衡(sagittal vertical axis,SVA)。结果 DLS组的LL值明显小于对照组,差异有统计学意义(P<0.05);PT、SVA值明显大于对照组,差异有统计学意义(P<0.05)。2组的SS、PI及TK值差异无统计学意义(P>0.05)。2组的SS与LL、PT与SVA均有相关性。对照组骨盆参数之间(PI、SS及PT)均有相关性,但DLS组骨盆参数之间均无相关性。对照组中LL与SVA显著相关,但DLS组中LL与SVA无相关性。结论骨盆形态的变化与脊柱的矢状位序列密切相关,DLS患者表现为更小的LL以及更大的SVA。

Objective To measure the spinopelvic paratmeters in patients with degenerative lumbar scoliosis（DLS）,and analyze their correlation and clinical significance. Methods From March 2006 to March 2014,30 patients with DLS（DLS group） and 30 subjects without DLS（Control group）,with complete imaging data were selected in the study. The anteroposterior and lateral roentgenographs of the total spine standing were used to measure the spinopelvic parameters,including Cobb＇s angle of scoliosis,pelvic incidence（PI）,sacrum slope（SS）,pelvic tilt（PT）,lumbar lordosis（LL）,thoracic kyphosis（TK） and sagittal vertical axis（SVA）. All spinopelvic parameters between 2 groups were compared. Results Of the DLS group,LL was significantly lower than that of the Control group;the difference was statistically significant（P 0.05）. The SVA and PT of the DLS group were significantly higher than those of the Control group;the differences were statistically significant（P 0.05）. The differences were not statistically significant in SS,PI and TK between 2 groups（P 0.05）. In both groups,there were significant correlations between SS and LL,PT and SVA. There was no correlation with all pelvic parameters（PI,PT and SS） in DLS group,while there was significant correlation with all pelvic parameters in Control group. In Control group,LL was significantly correlated with SVA,but LL was not correlated with SVA in DLS group. Conclusion The change of pelvic morphology is closely related to the sagittal sequence of the spine. Compared with Control group,DLS group has higher SVA and lower LL.